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Case Reports
. 2022 Aug 1;16(8):1-7.
doi: 10.3941/jrcr.v16i8.4391. eCollection 2022 Aug.

A "blood theft" after liver transplantation: the role of interventional radiology in the management and treatment of splenic artery steal syndrome

Federica Riva  1 , Enrico M Garanzini  2 , Tommaso Cascella  2 , Alfonso Marchianò  2 , Carlo Spreafico  2
Affiliations
Case Reports

A "blood theft" after liver transplantation: the role of interventional radiology in the management and treatment of splenic artery steal syndrome

Federica Riva et al. J Radiol Case Rep. .

Abstract

Splenic artery steal syndrome is a rare complication after liver transplant. It could lead to rapidly evolving major issues such as ischemic cholangiopathy and acute graft failure. Although the pathophysiology is not yet well understood, if diagnosed in time it could be easily managed with interventional radiology treatments. We present a case of a 47-year-old man presented to our institute with radiological findings typical for multifocal hepatocellular carcinoma in a cirrhotic liver. After therapy he underwent transplant. Some days after surgery he developed signs of acute liver failure. Steal syndrome was suspected by laboratory tests and radiology exams. The syndrome was confirmed by angiography and treated. The graft was saved, and the patient is still alive and free of disease. The purpose of this paper is to explain the importance of radiology exams in the diagnosis of splenic steal syndrome, explain its pathogenesis and describe the interventional management of this complication.

Keywords: CT; Hepatocellular carcinoma; SAS; US; angiography; embolization; interventional radiology; liver; orthotopic liver transplant; spleen; splenic artery steal syndrome; ultrasound.

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Figures

Figure 1
Figure 1. 47 years old male with acute liver graft failure
FINDINGS: Doppler US obtained after 5 days from transplant showing alteration of PS velocity and RI respectively in the hepatic artery (a) and the portal vein (b); hepatic artery velocity is very low. TECHNIQUE: Doppler ultrasound imaging
Figure 2
Figure 2. 47 years old male with acute liver graft failure
FINDINGS: Contrast-enhanced coronal CT scan reconstruction (a) documented patency of the hepatic artery (arrow). Reformat 3D (b). TECHNIQUE: Axial CT, 190 mAs, 120 kV, 1mm slice thickness, 90 ml Iopamiro 370.
Figure 3
Figure 3. 47 years old male with acute liver graft failure
FINDINGS: Pre-treatment digital subtraction angiography of celiac trunk which confirmed an altered flow distribution. Decreased flow in the hepatic artery (arrow). Portal early and splenic artery increased flow (arrowheads). TECHNIQUE: anteroposterior angiography with 30ml of Iopamiro 370.
Figure 4
Figure 4. 47 years old male with acute liver graft failure
FINDINGS: Digital subtraction angiography immediately after plug placement (a). Splenic collateral vessels and plug in the proximal splenic artery (arrowheads); hepatic artery flow restored (arrow). Detail of the positioning of the endovascular plug in the proximal splenic artery (b). TECHNIQUE: anteroposterior angiography with 30ml of Iopamiro 370.
Figure 5
Figure 5. 47 years old male with acute liver graft failure
FINDINGS: doppler US at 24 hours post-procedure showed an improvement of velocity and RI in the hepatic artery (a) and reduction of portal vein velocity (b). TECHNIQUE: Doppler ultrasound imaging
Figure 6
Figure 6. 47 years old male with acute liver graft failure
FINDINGS: contrast-enhanced US scan that excludes emerging hypoechogenic ischemic areas in the spleen after embolization. TECHNIQUE: Contrast-enhanced ultrasound imaging with 2ml of SonoVue (Bracco).
See this image and copyright information in PMC

References

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